What Is Miscarriage?

A miscarriage is defined as a pregnancy loss that occurs before 24 weeks of gestation, and is one of the most traumatic experiences a pregnant woman can go through. In the United States, some 15% of known pregnancies end in miscarriage. However, this number could be as high as 50%, since many women experience a miscarriage before they even know they are pregnant.

Why Do Miscarriages Occur?

This is a complex question that unfortunately has yet to yield any clear answer. However, normally a miscarriage will occur as a result of an abnormality during the conception process (as opposed to any environmental factors). The most common of these irregularities is a chromosomal abnormality in the fetus itself, which is responsible for some 70% of miscarriages that occur in early pregnancy.

A fetal abnormality is usually the result of an uneven splitting of the egg or sperm cells, causing the fetus to have too few or too many chromosomes. However, chromosomal abnormalities can also be produced by what is called a "blighted ovum" – or an empty pregnancy sac. Pregnant women who experience a blighted ovum will normally notice a sudden change in their pregnancy symptoms, sometimes accompanied by vaginal bleeding that is dark-brown in color. Any woman experiencing vaginal bleeding should seek medical attention, as this could also be a sign of other pregnancy complications, including ectopic pregnancy.

However, there are a variety of other factors that have been proven to increase the risk of miscarriage. These factors include:

Age: Women over the age of 35 are more susceptible to chromosomal abnormalities and as such are at a higher risk for miscarriage.

Medical Conditions/Infections: Having a medical condition such as diabetes, thyroid disease, or hormonal problems may increase your risk for miscarriage. In addition, a recent study has shown that women affected by bacterial vaginosis are nine times more likely to miscarry.

Lifestyle: The following lifestyle factors can also increase the risk of miscarriage: being obese or underweight, smoking, alcohol or drug use (both legal and illegal), excessive caffeine and malnutrition.

Radiation: Women who are exposed to radiation or other toxic substances also put themselves at greater risk for miscarriage.

Stress: Recent studies have shown that women who are exposed to stressful situations on a regular basis (whether at work or at home) during the first trimester are at a significantly greater risk of miscarriage than those who describe their lifestyle as being relaxed.

Signs of a Miscarriage

While a miscarriage is generally depicted as being a dramatic event, the unfortunate reality is that many miscarriages happen without the woman even being aware. However, there are some signs of miscarriage that pregnant women should be on the lookout for, such as vaginal bleeding (particularly if it is prolonged or heavy), weight loss and stomach cramping (similar to that experienced during PMS), as well as contractions.

Other miscarriage symptoms include the sudden disappearance of most early signs of pregnancy, including nausea, breast tenderness and fatigue.

Diagnosis & Treatment Options

In order to diagnose a miscarriage, your doctor will likely begin by asking you a series of questions about the overall progress of your pregnancy, followed by a physical exam (similar to a Pap test) to examine the pelvic area. In addition, your doctor may choose to perform blood or urine tests to verify the pregnancy and detect any abnormalities. Finally, an ultrasound may be performed to establish the status of the pregnancy.

As for treatment, that will depend on how far along the pregnancy was at the time of miscarriage. If the miscarriage occurs within 10 weeks of the pregnancy (or if you have a spontaneous abortion), it will generally terminate on its own. However, medical treatment may be needed if you are actively miscarrying – in other words, if you are still physically pregnant but no longer have a living pregnancy.

Surgical treatment usually involves one of two procedures: an evacuation of the retained products of conception (ERPOC), which is a very short procedure designed to empty the womb; or a dilation and curettage (D&C), which is a somewhat less common procedure involving the widening of the cervix so as to remove pregnancy tissue by gently scraping the womb.

Emotional Treatment While miscarriage is a physical occurrence, its effects are by no means exclusive to the body. In fact, the most damaging aspect of miscarriage is most often the effect it has on a woman’s (and her partner’s) emotional health. That’s why it is so important that women and couples who experience miscarriages seek help so that they can learn to move on.

Many women who miscarry choose to become pregnant again, and are successful. However, in order to prepare oneself both emotionally and physically for pregnancy, it is essential that women keep the lines of communication open between themselves and their partners, families, friends and medical professionals.

Preventing Miscarriage

While chromosomal abnormalities generally cannot be avoided, there are several measures a woman can take to lower her risk of miscarriage both when she is trying to get pregnant and once she knows she is pregnant:

Don’t smoke, drink or use any drugs unless under the advice of your health care professional

Avoid environmental hazards such as radiation or toxic substances

For more information on miscarriage, including coping strategies and recurrent miscarriage, visit womens-health.co.uk. For women who have had a miscarriage and are experiencing symptoms of depression, visit our mental health page on epigee.org to find out what options are available.